JAMIA: Decision support tools efficacious in CRC screening

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A study of personalized decision support (PDS) showed improvements to people's attitudes and beliefs about colorectal cancer (CRC) screening, increasing the likelihood they would engage in future CRC screening.

The study, in the Aug. 20 Journal of American Medical Informatics Association led by Katrina Lindblomb, a professor at the University of Adelaide School of Psychology in Adelaide, Australia, and colleagues investigated the efficacy of an web-based PDS to aid in the decision to screen for CRC.

The study tested whether the efficacy of the tool in influencing attitudes to screen was mediated by perceived usability and acceptability, and whether the role of computer self-efficacy and computer anxiety was considered.

The results of the study showed that the objective was only achieved in those people who perceived the tool as being usable and acceptable. Those who perceived the tool as unacceptable or not-user friendly showed no change in their attitudes toward CRC screening, although their knowledge about CRC and screening increased. Computer anxiety and computer self-efficacy were found to be determinants to the perceived usefulness and acceptability of the PDS, and are important factors in influencing the potential efficacy of the tool.

A finding about the perceived usability and acceptability of the PDS moderated the changes in all preventive health model factors but not CRC knowledge, according to the study. Rather, all participants experienced an increase in their knowledge of CRC and screening, regardless of whether they perceived the tool as being useful and acceptable or not. One explanation is that people who felt the tool was not acceptable or user friendly may have read the feedback and accepted the factual information (e.g., the risk of developing CRC increases with age), but they may not have changed their attitudes toward screening.

There was a 25 percent variance in the perceived usability and acceptability of the low computer self-efficacy and high computer anxiety of the PDS. These factors influenced users' perceptions of the tool. It has been proposed that interventions aimed at improving computer self-efficacy may be more effective in improving perceived usability and acceptability than modifications of the underlying technology (i.e., the PDS tool).

Computer anxiety was shown to be lower in people who have more experience with computers. Given the increase in computer use, computer ownership and Internet access, computer anxiety at a population level should decline due to increased interaction with the technology, the authors wrote. Computer anxiety has also been shown to decrease in people who have completed courses or training. Publicly funded computer courses for people older than 50 years may help decrease computer anxiety, leading to an increase in the perceived usability and acceptability of new technologies.

The researchers noted that further study is needed to assess whether computer anxiety, computer self-efficacy, and the perceived usability and acceptability of the PDS mediate changes in readiness to screen for CRC and screening behavior.